Op-ed: Cut Medicare payments for doctors, you’ll have fewer doctors

Medicare is planning to cut physician payment rates by 10 percent in 2008. These reductions will continue annually, and it is predicted that the total cuts will be about 40 percent by 2016.

The topic of physician compensation generally elicits little public sympathy. After all, the average primary care physician salary in 2006 was about $150,000. Who are we to complain about reimbursement? As you will see, however, cuts in physician Medicare payments affect everyone.

Medical practices today essentially function as small businesses. Physicians are responsible for expenses like rent, payroll, employee health insurance and malpractice insurance. These costs are expected to increase 20 percent in the next nine years. During this same time, physician Medicare payments are faced with cuts of 40 percent. Already, some practices lose money every time a Medicare patient is seen. Some may find the link between medicine and money distasteful, but the hard truth is that it is impossible to practice medicine in a business model that is headed for financial disaster.

At a time when baby boomers are approaching the age of 65, some physicians attuned to this economic reality have simply stopped accepting Medicare patients. According to a recent survey by the American Medical Association, 60 percent reported that they would have to limit the number of new Medicare patients they treat due to next year’s cut. Half would reduce their staff. Fourteen percent would “completely get out of patient care.” Some seniors are already faced with calling 20 to 30 providers in the desperate hope that someone will accept Medicare.

It is unlikely that the primary care shortage will improve in the near future, as Medicare reimbursement rates continue to be a primary driver of physician salary. In a report by the Center for Studying Health System Change, incomes of primary care physicians fared amongst the worst in keeping pace with inflation between 1995 and 2003, while medical specialists fared the best.

Medical students, already burdened with an average debt in excess of $100,000, are clearly gravitating towards specialties where salaries have better kept pace with inflation. The report concludes that with “the diverging income trends between these specialties and primary care, the result is likely to be an imbalance in the physician workforce and perhaps a future shortage of primary care physicians.”

Some may be wondering if this is just a “Medicare problem.” Should you care if you have private insurance?

Absolutely. With primary care being the backbone of every health system, patients cannot have their chronic medical issues addressed in a timely fashion with a lack of primary care access. In delaying care, chronic diseases blossom into more serious conditions that are forced to be seen in already overcrowded emergency rooms.

Hospital-based care is often the most expensive and the corresponding rise in health care costs plays a major role in the increase of health insurance premiums. Unfortunately, the government responds to rising health care costs by further reducing physician payments and the cycle continues to spiral out of control.

You will hear physicians rallying against the Medicare fee reductions in the coming year. Think about how this affects you. Contact your government representative and do your part to break this vicious cycle.

Comments are moderated before they are published. Please read the comment policy.

Anonymous

Man, it is almost like Latrelle Sprewell (sp) talking about not being able to feed his children on his meager earnings. Highest paid profession by median income and it still isn’t enough. Either serve the patient population or step out of the way.

john

It’s like this Anon 12:37– ya gotta imagine that instead of getting a 3% raise plus xmas bonus every year, your boss says he’s going to pay you less than last year because “the budget” won’t allow for even a maintenance of your current wage.

Would you be happy? Of course not.

Anonymous

The reality of which Kevin fears is already here. Just try to get any top specialist to see a Medicare patient these days.

Alijor

I completely agree. As far as sympathy for physician payments go- ok, sure, physicians make money…but a lot of people become physicians *to make money*. Lots of people may *want* to, but not only is it a really demanding job, but it requires medical schooling (read: very very expensive and lots of loans). Physicians payments should be a concern, because the more doctors, the more treatment (which would make payments, in the long run, go down for consumers anyway). That’s pretty simple- even if you force physicians to accept Medicare. Do you agree?Cheers,Alijor (Alijor.blogspot.com)

Melanie

I do Medicare Billing for a living in a rehab setting, and let me tell you, its also the Suppliers for wheelchairs, hospital beds and all durable medical equipment. Both physicians and suppliers are in need of working double time to knock sense in to the government, more than I care to admit to. Bad enough I have to fight the upper end of management over what we CAN and what we CANT bill, Ive got the job of also fighting our government as well. I dont envy ANYONE who has to fight Medicare.. its an activity that no one should ever have to do!

Anonymous

Doctors are simply lying in the bed they made 40 years ago.

JoshMD

I appreciate the argument that doctors work hard, have many years of education and spend buckets on loans as justification of our “high incomes.”

And all of those are good reasons but they aren’t the ‘right’ reason. We get paid what we get paid (high or low) b/c of the service we provide. If you don’t want my medical knowledge, then you’re not paying me anything. Problem solved.

If however, you or a loved one is sick and wish to utilize my 12+yrs education/residency that i’ve paid (OH so dearly for) then you’ll be willing to pay my fee. If i work hard and provide a lot of serice to a lot of people i’ll make a lot of $$. End of story. No excuse or explanation required.

However, we can respectfully disagree on this issue. If you, as a tax payer and a (eventual) patient feel that my services are not worth what I ask, then it is your right/duty to petition the gov’t to decrease my pay. For better or worse, you get what you pay for. And if a time comes when you want more quality/accessibility/etc from your medicare/caid providers, you may suddenly become more sensitive to the issues Kevin and others are mentioning.

Who’s laying in the bed they’ve made ANON 6:37…

POI: Doctors are NOT the highest paid profesion, average, mean, median or anything else. Check out Salary.com for the proof.

Kevin, that was a very well written article. Medicine is a small business as well as a calling. Unfortunately, the calling does not pay our bills. In all business, falling revenue coupled to rising costs spells doom. In urology, for example, while $200 for a vasectomy, per say, may seem like a lot to a consumer, at that rate, most urologists simply can not afford to do vasectomies, because the $200 is less than the hourly cost of doing business. To that effect, people will say that our costs are simply too high. I agree. But we are not to blame for those costs. Rent, leases on equipment, payroll for staff, insurance, phones, fax, and electric all add up to well over $150K per year, revenue that we must earn before any of us see a single nickle of income. Kevin, thank you for writing your important article.

Anonymous

Ugh. The same old nonsense about why providers deserve to earn what they earn. And do you have to wonder why these posts always turn into a discussion of basic economics regarding what happens to compensation rates with supply limitations? Go check the NBLS database and let us know what the highest median after-expense compensation field is. Finally that 150K is an after-expense figure. Again, if you are not willing to keep up your end of the bargain when the government has kept up its end by allowing you to have a protected racket then perhaps it is time to step aside and stop trying to keep others that can provide basic healthcare services from providing them at reasonable rates.

Anonymous

Anon 10:23:Perhaps you should fill us in on your job and how often you have tolerated payment cuts in your position. No smartass remarks just your experience.

“perhaps it is time to step aside and stop trying to keep others that can provide basic healthcare services from providing them at reasonable rates.”

Try reading the article. Kevin’s WHOLE POINT was that by cutting medicare rates, there would be lack of access. If you refer to NP’s/PA’s, they have their place. But make no mistake, an NP/PA does not have close to the training of a board certified, experienced doc. Expecting them to step into doctor’s shoes because they are “cheaper” shows how little you know about medicine.

Anonymous

The solution is simple. Don’t take Medicare. Don’t take Medicaid either. End of story.

It always amazes me that docs bitterly complain about reductions in reimbursement from public and private payors, yet continue to take them year after year.

I wonder- Are any of the docs on this board truly planning to dump Medicare if reimbursements decline? The answer is most likely none.

As long as most docs are willing to take the cuts, they will keep reducing them. It’s a race to the bottom, and we arent even close to the end.

Docs are trained to be so risk-averse, that they will take any cut for fear of losing even the most meager returns.

In other words, get some balls or stop complaining.

Happyman

“Are any of the docs on this board truly planning to dump Medicare if reimbursements decline? The answer is most likely none.”

excellent point, and you are right – probably less than 5% of docs will stop seeing medicare patients even with the projected decrease. This is because medicare, both directly & indirectly, dictates doctors’ incomes. What will eventually happen, rather, is that more and more PCPs will get out of medicine altogether & do something much less demanding where you can make a low six-figure income.

Anonymous

Although I agree with anon 1151’s prescription for dealing with the problem, unless he has assumed the responsibility of taking care patients, diagnosing them and treating them medically or surgically, I would request that he keep his mouth shut about doctors not having any balls.

Anonymous

NPs and PAs would do just fine filling the grandiose shoes of the MD. I think that even the MDs realize this and that is why they are fighting so hard to keep the NPs and PAs oppressed through their war of aggression. If the NPs and PAs do a poor job then people will stop seeing them. Give the consumer the choice of how to spend their money rather than the current system of government extorting the producers to line the providers pockets when it comes to these socialist programs.

Happyman

anon 2:46 wrote “NPs and PAs would do just fine filling the grandiose shoes of the MD. “

you will indeed get your wish – when want a z-pak for that cold, you can go to a minute-clinic & it WILL be filled upon request by you, the “consumer”.

However when you are REALLY sick & go to an ER with “indigestion” and see an NP or PA who gives you maalox & sends you packin’, I hope your undertrained “provider” didn’t miss that MI, appendicitis, etc.

It never ceases to amaze me – people who pay $500 for a handbag will stick nickel-and-dime when it comes to their health. They will indeed get their wish, but will regret having wished for “cheaper” care.

Anonymous

I have worked as a primary clinic manager employing both MDs and NPs. The NPs all tended to over-consult specialists. They were smart people who recognized their limitations, and send EVERYTHING to multiple specialists. They ordered EVERY scan and EVERY lab they could think of or look up when a complex patient presented. I don’t think they hurt the patients – but they sure were NOT cheap in the big picture. The primary care MDs, being much better trained, were able to keep much of that in-house. For the average complex Medicare-aged patient with diabetes/CAD/COPD/arthritis/mild renal insufficiency, the patient could see one MD equipped to manage those conditions if he had a well-trained primary care physician. But if he had a nurse practitioner, he would see her PLUS his cardiologist/pulmonologis/endocrinologist/nephrologist/rheumatologist.

Anonymous

To anon 2:09, Um, as a neurosurgeon, I think I know a bit about responsibility for taking care of critically ill patients, taking care of every backache dumped on me by the local PCPs, putting in ICP bolts at 2AM at a Level 1 trauma center and taking on major liability for often little or no reimbursement.

And yes, most docs have NO balls when it comes to standing up to payors. BTW, it is some arrogance on your part to assume that only a non-physician would say so. The truth hurts.

Anonymous

I agree. Physicians are by nature, risk-avoidant when it comes to managing financial negotiations in the business side of their practices, whatever confidence they display in their clinical work. As bussiness men, we are idiots. We do not act to protect the economic value of our product. The government has a responisbility to the taxpayer to purchase whatever services it purchases at the lowest possible rate. To them it is a simple economic analysis: If docs continue to take the work after the rates are cut, the old rate was too high. It is not simple economics of course, because docs have a huge guilt barrier over not taking Medicare, about turning any patient away in fact. I didn’t take Medicare once. My parents stopped speaking to me. That is the advantage the government has–doctor’s mothers.

Anonymous

“excellent point, and you are right – probably less than 5% of docs will stop seeing medicare patients even with the projected decrease. This is because medicare, both directly & indirectly, dictates doctors’ incomes. What will eventually happen, rather, is that more and more PCPs will get out of medicine altogether & do something much less demanding where you can make a low six-figure income.”

If that’s your threat, that someday and somewhere physicians will quit practicing, it’s not very viable.

As for other jobs, they always seem easier when you’re not doing them, I guess.

Happyman

i guess what i meant to say was that more PCPs will get out of CLINICAL medicine.

This is happening already – working in an administrative capacity e.g. for a hospital, an insurance company, or one of the growing doctor-monitoring firms that review charts.

when “nurse managers” in a hospital are paid $100k + to make sure real nurses are doing their job, something is really screwed up. it doesn’t take long to figure that the MD can be used to make that much without the headaches of patient care.

Anonymous

If that’s your threat, that someday and somewhere physicians will quit practicing, it’s not very viable.

What!?!?!? This is happening already – I see it all around me.

What happened to Dr B?

He quit his practice and went to work for industry.

What happened to Dr. C?

He quit his practice and works for the hospital doing U/R.

What happened to Dr. H?

He is only working part time as he build his law practice.

What happened to Dr. P?

She quit practice, and is a stay-at-home mom.

What happened to Dr. O?

He quit his practice, and went to work in academia.

What happened to Dr. S?

She quit her practice and now works part time, 2 afternoons a week, for a a walk-in-clinic.

These are all people I know. They were all fed up, looked around for something else, and as soon as they found it, poof, they quit. They are all much happier now. Some of them were not primary care, and left a serious supply shortage in their specialty, in the area. Oh well.

Not viable? Think again. All of these people, whom I know, left their practice because of declining reimbursements and increasing government/beureacratic hassles.

Mike

I am so sick of this “gov’t should pay the lowest price for service” bullcrap! Why should physicians be the only ones whop get screwed sucking at gov’t teat??? Ever heard of the pentagon paying 1000 bucks for a nail??? How many “no bid” contracts went out for the current war? Does anyone think HAlliburton was really the “best deal” EVERYTIME???

Bottom line: If you want that Board certified doctor available when you want, with the training you expect, then you cant just pay him a large amount when its convenient for you, and then screw him/her the rest of the year!

And we’re not scared of NP/PA’s doing our job better. Were scared that they’ll take the simple business and leave us with the REAL lengthy visits, of which we get paid the SAME DAMN AMOUNT regardless of time spent! Primary care needs a balance of both. But by sucking them away to the NP’s, you just hasten the demise of primary care.

Good job America.

Happyman

they should just call the minute-clinics “zpak/cialis clinics” – perhaps there can be a checklist to be filled out by the “customer” upon registration:

Are you here for a) erectile dysfunction; or do you b) have a cold & need antibiotics. We will be happy to contact your primary care doctor upon filling your request so we can pass on the liability to him/her but reap the financial benefit of this limited-scope visit. Thank you, come again, here is a coupon for $10 off your next visit and a free cup of coffee from the snack bar”.

Anonymous

To the neurosurgeon:

With respect to my assuming that you weren’t a physician, please note that I said: “unless he has assumed the responsibility”, which considers the possibility that you were a physician. Additionally, if you’ll notice, I agreed with your prescription, so it wasn’t necessary to reiterate your point.

However, I still feel there are a few flaws in your prescription:

1) most notably, are you able to refuse to treat the medicaid patients you have to see in the ER when you’re on ER call?

2) I think the root of physician’s problems when it comes to negotiating with payors may have more to do with their lack of poor accounting than their lack of male genitalia. In contrast to corporations like McDonalds, which conduct cost based accounting and can therefore tell you exactly how much it costs a franchise to produce a Big Mac, I don’t think many doctors have any idea how much it truly costs them to see a patient in the office for a given level of condition. Given this lack of information, how are they supposed to argue with the payor that their reimbursement for x,y, or z is too low?

BTW, I will take the high road here and not end with any cheap shots….

Anonymous

To the anonymous neurosurgeon: I am a “local PCP”. My local neurosurgeons will not see a back pain patient of mine until the MRI is back showing an operable lesion. Let your local PCPs know that you think they are dumping on you. It won’t be a problem any longer.

Anonymous

Yes, unfortunately I am currently forced by my main hospital to see every neurosurgical pt. that comes into the ER, including Medicaid and “No-caid.” We did negotiate some call reimbusement for this, which at least partially offset the loss.

In the office, we place strict limits on public assistance and Medicare patients. If reimbursements actually fall, I plan to d/c new Medicare. We have had a few false alarms on this, so we’ll see.

You are correct in that most physicians have no idea how much it costs to actually see a patient. Its more than many think. My solution has been to expand into imaging, physicial therapy, pain managment, and outpatient surgery. Regular office visits are break even at best- just running on a treadmill. Docs need to expand their horizons and realize that payors reward diversity in treatment and horizontal integration. Just my experience.

Anonymous

“Not viable? Think again. All of these people, whom I know, left their practice because of declining reimbursements and increasing government/beureacratic hassles.”

You should welcome that. It makes your skills more valuable. Now, you should exploit that scarcity to cut a better deal for yourself.

Anonymous

“You should welcome that. It makes your skills more valuable. Now, you should exploit that scarcity to cut a better deal for yourself.”

Here’s the problem when it comes to taking care of our senior citizens. If I completely drop out of Medicare, then, if I need to get back in, by federal law, I have to wait 2 years (from the date of dropping out) to once again participate. Each patient gets an individual contract for care, and he/she can’t get reimbursed by Medicare. I can elect to go non-par, which means I can accept assignment on a case by case basis, but, again by federal law, can’t collect more than 115% of the allowed reimbursement. The check goes to the patient. While you can charge upfront in the office, try collecting from a dead patient who you saw in the hospital. You can accept assignment on such a patient as a non-par, but will only get 95% of the already low reimbursement. So – screwed, by law (!!!) and not by choice.

Anonymous

And we’re not scared of NP/PA’s doing our job better. Were scared that they’ll take the simple business and leave us with the REAL lengthy visits, of which we get paid the SAME DAMN AMOUNT regardless of time spent! Primary care needs a balance of both. But by sucking them away to the NP’s, you just hasten the demise of primary care.

No body said anything about doing your job better than you. Even if they do the job 75% as well at a fraction of the cost then it should be up to the individual patient to decide if that extra 25% is worth the extra cost. I do think it is fear in that there is a realization that enough would choose the less qualified at the much lower rate. As far as primary care goes… kill it now. Let the MDs do the specialist work and let others handle the primary care work.

Panda Bear

As far as not knowing how much it costs to take care of patients, that’s the problem. We regularly have patients sent to the “Urgent Care” side of our Emergency Department (non-acute, colds, minor complaints)who turn out needing admission for something really serious. Perversely, many of the patients on the “Grown-up” side turn out to have nothing.

Medicine is not about check boxes and neat algorithms. Patients are unpredictable and some of them are medical booby-traps. We are not making widgets wiht fixed costs and predictable inputs and outputs. Medical economics are rational on the macroscopic level but down at most of our levels things are very unpredicatable…which is why so many PCPs are going to stop accepting medicare patients who, after all, could be train wrecks who will suck up vast amounts of the physician’s time but reimburse no better than someone presenting for a cold.

Anonymous

What no one is saying outloud is that the elites already have figured out that we don’t need good health care in this country, and they are willing to sacrifice it for corporate profits. The decision makers will always be able to purchase superior care for themselves to optimize their own opportunities for a vigorous and long old age.

For the economy as a whole, however, healthcare is a drag–for more efficient for the sick and crippled to die sooner rather than later, and as cheaply as possible. The vigorous and productive don’t need much healthcare, and the sick and lame aren’t needed.

It isn’t that they don’t see what Medicare cuts will do, rather it is that they do see it and accept it.

Richard

I think one thing that keeps getting left out of this discussion is that, by in large, physicians are altruistic. We want to help people. We don’t want to leave patients out in the cold. We want to make health care work.

When reimbursements are continually cut for primary care, medical students will continually choose to prefer specialties over primary care.

Which creates a problem we’ve all foreseen for decades: A shortage of primary care physicians, while those who remain are often frustrated at the situation.

This leaves PCPs with 3 options:a.) be a “bad doctor” and only see patients who are profitable

b.) destroy their family life and work ridiculous hours to avoid bankruptcy

c.) quit and go into something else that makes more money (which isn’t all that hard to do).

Since option (a.) runs counter to the beneficent ethos of medicine, most doctors avoid that route, and current government restrictions make it harder to exercise option (a.) for some doctors(if you’re on call, you have to take the patient).

Which leaves either workaholic PCPs or PCPs who retire early and do something else. The vicious cycle continues, the meltdown of American health care continues, and doctors keep on warning the public that the destruction of primary care is only making things worse…. to seemingly no avail…

Anonymous

“c.) quit and go into something else that makes more money (which isn’t all that hard to do).”

Why do physicians believe this? If you’re a bad businessman in one field, what makes you think you’ll be any better in another? Making money is making money, no matter what industry.

Anonymous

“Why do physicians believe this? If you’re a bad businessman in one field, what makes you think you’ll be any better in another? Making money is making money, no matter what industry”

Clearly spoken by somebody who knows nothing of the business of medicine. Doctors’s don’t get paid via what the free market will tolerate or via ability. They are paid via what the government determines is the price per visit, procedure, etc. Private insurance keys of medicare rates. Being a good or bad businessman has nothing to do with it. I for one would love to have a free market system in medicine. But it isn’t going to happen. All you have shown anon is you nothing about the business side of medicine and our inability to pass on our cost increases to the consumers (unlike your profession). So doctor’s (PCP’s especially) go faster and faster on the hamster wheel. Which results in increased burnout, increased chance of errors, and unhappy patients and doctors. The winners here are the government and the lawyers at the expense of patients and doctors.

Anonymous

If you don’t have any experience in the free market, and you continually enter into bad agreements with the government and with health insurers, why are you going to be any better at negotiating deals in any other setting?

Most of you have never had to market your skills, because those contracts supply your “customers”. I completely understand your system, and it has nothing to do with the real world. But a bad deal is a bad deal, and if you can’t recognize it in medicine, how do you plan to recognize it anywhere else?

Anonymous

“Why do physicians believe this? If you’re a bad businessman in one field, what makes you think you’ll be any better in another? Making money is making money, no matter what industry.”

I’ll tell you from first hand experience: I did quit clinical medicine to start a business, and its quite miraculous how good a businessman you can become when you have time to review financial statements, develop business relationships, study the marketplace, etc.

Many docs could be good businesspeople, its just that clinical duties are so overwhelming, that there is simply no time or energy to deal with it.

Anonymous

“I completely understand your system, and it has nothing to do with the real world. But a bad deal is a bad deal, and if you can’t recognize it in medicine, how do you plan to recognize it anywhere else?”

Because CJD I used to work in private biotech firms before going back into medicine. I know a fair amount about the “real world”. Yes, medicare/medcaid/HMO’s are a bad deal. But unless you are a elective procedure doc/concierge doc there is no alternative. Saying simply “don’t sign the contract” shows how little you know about the business of medicine (despite what you think about completely understanding out system). The vast majority of patient’s have one of the big three types of insurance and unless you fall into a niche specialty that can charge cash you have no choice or you don’t have patient’s. It is that simple. How many times do people on this blog have to explain this to you? Are you dense or just stupid? Yes you can drop on or even two of the big three types of insurance but unless you fall into a niche specialty, dropping all three is not an option for most of us. Do you work in private practice or are you a government lawyer? Becasue frankly every one of your comments shows A: You know nothing about the business side of medicine and the government/nongovernment monopolies in payers.B: I strongly wonder based on your comments if you are even in private business yourself.

Anonymous

The guy who left private business for a career he says is a bad deal is lecturing others on economics.

Ahh, sweet irony.

You don’t have to sign the contract. Physicians existed before Medicare/Medicaid and even today they exist without utilizing those contracts. They even *gasp* find time to blog about it. Although how they afford the internet service I don’t know.

Criticizing others doesn’t undo your bad choices. Sack up and be a man and take responsibility for something once in awhile.

Mike

Anon 11:59… you forget that specialists don’t WANT TO SEE those patients who have primary problems that are complicated. And who is going to refer them? The NP and PA? What if they send them to the wrong specialist cause they just dont have a good sense? You seem to think that its 75% as good to see an NP. Where did you get this formulation?? I had an NP ask me to look over an EKG for them cause they “just werent sure”. How does THAT make you feel? Guess she can refer to a cardiologist. Good way to rein in costs… get a bunch of pointless, useless consults and tests, AND to boot, use up the time a specialist could have been seeing someone who could actually benefit from their expertise.

Primary care itself is the way to contain costs. If only the dopes who post here would realzie it, instead of berating it.

Anonymous

“You don’t have to sign the contract. Physicians existed before Medicare/Medicaid and even today they exist without utilizing those contracts. They even *gasp* find time to blog about it.”

You just don’t get it CJD. Tell you what. Why don’t you look up and find the statisitic’s about all those docs who make it without medicare/medicaid/private insurance. Put your money where your mouth is. I have been in this field for for well over a decade (after training) and have yet to see such a doc (outside of concierge/elective procedure types). Do show me all those docs out there is the hardcore fields of medicine and surgery making it on cash patient’s. Good luck. The simple fact is the big three have a monopoly on patient’s. Get back to me when you find the stats.

“Sack up and be a man and take responsibility for something once in awhile.”

I take responsibility for every patient I see, ALL THE TIME. That is real responsibility, not throwing out childish, uninformed, anonymous, insults on the internet.

Anonymous

“I take responsibility for every patient I see, ALL THE TIME.”

That’s great, but all professionals take responsibility for their patients/clients. I’m talking about taking responsibility for the financial choices you’ve made. Something you seem unwilling to do.

At the end of the day, you continue to expect different results from doing the same thing. Why, I don’t know. But if that’s how your mind works, you definitely don’t need to be in the truly free market.

Anonymous

CJD: I am still waiting for the data that you specifically CAN’T SHOW. Leave out your worthless statements and put your money where your mouth is. Unlike you, I’ve worked in this business. I know the people who are and are not taking insurance/medicare/medicaid. I know how the only ones who cannot fall into the niche specialties and how the rest of us are stuck because pt’s are monopolized by the big three. Either show me some data to support your statement or keep your clueless statements to yourself. As I stated, I have worked in a free market system (outside of medicine) and in this system. I know the difference. Do you?

Anonymous

Well CJD Your silence speaks volumes. Get back to me when you have some evidence to support your statements

Anonymous

Anon:You will be waiting a long time for evidence from his ilk. He is the smoke and mirrors type not evidence-based.

Anonymous

Bill like a dentist.Amazing that the dentist accepts “insurance” covering less than half of my dental cleaning and I pay the rest ($75 + $75).My patients whine about the copays and the expense of their urology visit.1. Medicare WILL be bancrupt by 2017 as the baby-boomers reach the age of 65 (50% are 60)2. Fee-For-Service will become more popular. Either see the FMG (foriegn med grad) in a VA (Veterans Assoc) style system…and take a number and wait or pay the difference in what your insurer provides to get good care.3. Deregulate Medicine. Let the docs be the McDonald’s. Cut my salary but allow me to own the lab/ct scanner / hospital / surgical center and accept all because of my better product for less.STARCK and anti-trust b.s. is rediculous! DE REGULATE the industry. Let private enterprise SHINE!

Anonymous

It is amazing how the public will pay high ticket prices to see their favorite professional athletes, who make millions hitting a white ball or put an air filled piece of leather through a hoop, yet scream bloody murder when they get a medical bill. What’s more important, entertainment or your life?

Look at the problems with trauma, which happens to be the leading cause of death for those 20 – 45. Nobody wants to pay for a trauma system or subsidize physicians who take care of these patients, who are disproportionately uninsured. So right now, unless you are in an urban setting, you will have a long wait and transfer time to a place where a surgeon is willing to take care of you after you smash yourself into a telephone pole. People are dying in the process. If you don’t think this is happening, then get your head out of your ass.

Complain all you want about how much doctors make. They earn every cent. Stop paying, then you will see doctors no longer willing to get out of bed at 2 am to see you in the ER. This is already happening.

What is worth more to you, your big screen TV or someone who can stop your internal bleeding at 4 am?

Troy

Health care is probably the most elastic service on the market; in terms of, if the situation is right, people will give every dime they have for the surgery that will save their leg. This price floor that the government is instating is almost ridiculous to me. For a well educated specialized doctor, it is 13 years of post high-school training, as I’m sure most of you know, not to mention the loans and time spent getting to where they want to be. All of those costs should be reimbursed by a good salary, look at lawyers! Sure you can go grab a free public defendant, but your not going to win the case, but you now can go to the best doctor in America and whip out a card that will save you a few grand?

Anonymous

I am sorry to see all the anger in these blogs. As an RN (working on my master’s degree for FNP) who is married to a physician, I try to see all sides of the coin. First, We do not live in a mansion, my children do not wear designer clothes and we (like everyone else) live with a mortgage and budget. We own our own practice, situated in a small town. It is extremely challenging to run any small business. Medical practices are harder than most other businesses because we cannot control costs (usually dictated by inflation), nor can we control what we charge. When Medicare cuts reimbursement, the private insurance companies do the same, United Health Care usually leads the way. So to say, “Stop taking Medicare” really doesn’t help the financial aspect. Physician’s (and other providers) would have to stop taking all insurance. Some practices are doing just that. But that is not the reason any of us went into medicine or nursing. We wanted to help mankind. And most of us still do. The problem is how to do it without going bankrupt. My husband and I work 24/7 to keep our practice running. I answer the phones on the off hours and triage each patient. Our teenage children earn their spending money by cleaning, painting and keeping up the office. And my husband starts his day at 6:30 am. Makes rounds at two hospitals, gets to the office at 9:00 and sees patients until they are gone, usually around 6:00 pm. Then he spends two more hours returning patient calls and doing paperwork. Although the office hours are 9-5 with an hour for lunch, he doesn’t finish until 8 or 9 pm, frequently doesn’t get a lunch because he is finishing seeing the morning patients and is forced to take hospital ER call (which he is rarely paid for). Last year his salary was a whopping $100,000.00, but the practice lost $20,000.00, so in reality, he made $80,000.00. Why does he do it? Because he Cares! That seems to be forgotten in all this fighting. Lets try to work together to develop ways to enable our profession to care for all our patients. Right now, HR 6129 needs support. It will not increase Medicare payments, but it will stop the immediate cuts. Please contact your legislators to support this bill. Working together, we can make health care accessible and affordable. CaringRN

Anonymous

I am a third-year resident in a primary-care specialty and am happy to tell y’all that every single resident I know is thinking of cash-based practice. We all hate medicare/medicaid and the other insurances aren’t much better. Sure, we will such it up for a couple of years hamstering for some multi-specialty group, but the majority of us will abandon these slavedrivers in a heartbeat when we get a better opportunity. One of my best friends in the residency program is going to start working for a gym (!!) when he graduates. Lawyers and politicians have destroyed primary care in America and they will get what they deserve and I’m not shedding a single tear over it.AyurMD